Atrial Natriuretic Peptide and Chronic Renal Failure

  • W. Rascher
  • M. Bald
Conference paper


Experimental and clinical studies are reviewed on the role of atrial natriuretic peptide in fluid volume and cardiovascular homeostasis in chronic renal failure. In patients with end-stage renal disease, atrial natriuretic peptide is elevated prior to hemodialysis and lowered by hemodialysis, hemofiltration or ultrafiltration. Volume overload is the most important stimulus for elevation of plasma ANP in chronic renal failure, and concomitant cardiac enlargement and arterial hypertension may play a role.

Plasma ANP does not contribute to longterm regulation of sodium homeostasis, but is released in an exaggerated manner in response to acute volume load in chronic renal failure. Plasma ANP is a useful index of volume overload in patients with chronic renal failure.

Key words

Atrial natriuretic peptide Chronic renal failure Continuous ambulatory peritoneal dialysis Hemodialysis Hemofiltration Volume overload 


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  1. 1.
    Anderson JV, Raine AEG, Proudler A, Bloom SR (1980) Effect of haemodialysis on plasma concentrations of atrial natriuretic peptide in adult patients with chronic renal failure. J Endocr 110: 193–196CrossRefGoogle Scholar
  2. 2.
    Cannella G, Rodella A, Brunori G, Gaggiotti M, Sandrini M, Maiorca R (1987) Plasma concentrations of atrial natriuretic peptide in relation to body fluid status in chronic uraemia. Nephrol Dial Transplant 2: 158–160PubMedGoogle Scholar
  3. 3.
    Cole BR, Kuhnline MA, Needleman P (1985) Atriopeptin III — A potent natriuretic, diuretic, and hypotensive agent in rats with chronic renal failure. J Clin Invest 76: 2413–2415PubMedCrossRefGoogle Scholar
  4. 4.
    Czekalski S, Michel C, Dussaule JC, Touraine P, Mignon F, Ardaillou R (1988) Atrial natriuretic peptide and adaption of sodium urinary excretion in patients with chronic renal failure. Clin Sci 75: 243–249PubMedGoogle Scholar
  5. 5.
    Deray G, Maistre G, Basset JY, Cacoub P, Carayon A, Anouar M, Baumelou A, Legrand JC, Ancri D, Jacobs C (1988) Plasma levels of atrial natriuretic peptide in chronically dialyzed patients. Kidney Int 34 [Suppl 25]: S86 - S88Google Scholar
  6. 6.
    Eisenhauer T, Talartschik J, Scheler F (1986) Detection of fluid overload by plasma concentration of human atrial natriuretic peptide (h-ANP) in patients with renal failure. Klin Wochenschr 65 [Suppl VI]: 68–72Google Scholar
  7. 7.
    Espiner EA, Nicholls MG, Yandle TG, Crozier IG, Cuneo RC, McCormick D, Ikram H (1986) Studies on the secretion, metabolism and action of atrial natriuretic peptide in man J Hypertens 4 [Suppl 2]: S85–S91Google Scholar
  8. 8.
    Goetz KL (1988) Physiology and pathophysiology of atrial peptides. Am J Physiol 254: E1 - E15PubMedGoogle Scholar
  9. 9.
    Hasegawa K, Matsushita Y, Inoue T, Morii H, Ishibashi M, Yamaji T (1986) Plasma levels of atrial natriuretic peptide in patients with chronic renal failure. J Clin Endocrinol Metab 63: 819–822PubMedCrossRefGoogle Scholar
  10. 10.
    Hodsman GP, Jackson B, Debrevi LM, Ogawa K, Johnston CI (1987) Atrial natriuretic factor in chronic renal failure: Studies in man and the rat. Clin Exp Pharmacol Physiol 14: 247–251PubMedCrossRefGoogle Scholar
  11. 11.
    Jahn H, Schohn D, Schmitt R (1981) Hemodynamic studies in chronic terminal renal insufficiency — Effects of hemodialysis, hemofiltration and ultrafiltration procedures. Nephrologie 2: 53–62PubMedGoogle Scholar
  12. 12.
    Luft FC, Lang RE, Aronoff GR, Ruskoaho H, Toth M, Ganten D, Sterzel RB, Unger T (1986) Atriopeptin III kinetics and pharmacodynamics in normal and anephric rats. J Pharmacol Exp Ther 236: 416–418PubMedGoogle Scholar
  13. 13.
    Luft FC, Sterzel RB, Lang RE, Trabold EM, Veelken R, Ruskoaho H, Gao Y, Ganten D, Unger T (1986) Atrial natriuretic factor determinations and chronic sodium homeostasis. Kidney Int 29: 1004–1010PubMedCrossRefGoogle Scholar
  14. 14.
    Morris M, Cain M, Russell A, Elliott J, Chalmers J (1987) Direct radioimmunoassay of human plasma atrial natriuretic peptide in various normal and pathophysiological states: Increase in renal and cardiac failure during exercise. Clin Exp Hypertens A9: 703–718CrossRefGoogle Scholar
  15. 15.
    Needleman PH, Greenwald (1986) Atriopeptin: A cardiac hormone intimately involved in fluid, electrolyte, and blood-pressure homeostasis. N Engl J Med 314: 828–834PubMedCrossRefGoogle Scholar
  16. 16.
    Pacher R, Frass M, Hartter E, Woloszczuk W, Leithner C (1986) Continuous pump-driven hemofiltration associated with a decline in alpha-atrial natriuretic peptide. Crit Care Med 14: 1010–1014PubMedCrossRefGoogle Scholar
  17. 17.
    Predel HG, Bäcker A, Kipnowski J, Düsing R, Kramer HJ (1987) Relationship of plasma concentrations of human atrial natriuretic peptide to renal function and blood pressure in patients with progressive chronic renal failure. Klin Wochenshcr 65 [Suppl VIII]: 127–132Google Scholar
  18. 18.
    Pruszczynski W, Viron B, Gzekalski S, Mignon F, Ardaillou R (1987) Role of cardiac parasympathetic dysfunction in atrial natriuretic peptide response to volume changes in patients with chronic renal failure. Mineral Electrolyte Metab 13: 333–339Google Scholar
  19. 19.
    Rascher W, Bald M, Kreis J, Tulassay T, Heinrich U, Schärer K (1987) Atrial natriuretic peptide in infants and children. Hormone Res 28: 58–63PubMedCrossRefGoogle Scholar
  20. 20.
    Rascher W, Bald M, Kröner F, Tulassay T, Müller-Wiefel DE (1988) Klinische Wertigkeit der Messung des atrialen natriuretischen Peptids im Plasma von Kindern mit chronischer Nierensuffizienz. Z Kardiol 7 [Suppl 2]: 61–64Google Scholar
  21. 21.
    Rascher W, Tulassay T, Lang RE (1985) Atrial natriuretic peptide in plasma of volume-overloaded children with chronic renal failure. Lancet II: 303–305Google Scholar
  22. 22.
    Saxenhofer H, Gnädinger MP, Weidmann P, Shaw S, Schohn D, Hess C, Uehlinger DE, Jahn H (1987) Plasma levels and dialysance of atrial natriuretic peptide in terminal renal failure. Kidney Int 32: 554–561PubMedCrossRefGoogle Scholar
  23. 23.
    Shenker Y, Port FK, Swartz RD, Gross MD, Grekin RJ (1987) Atrial natriuretic hormone secretion in patients with renal failure. Life Sci 41: 1635–1644PubMedCrossRefGoogle Scholar
  24. 24.
    Smith S, Anderson S, Ballermann BJ, Brenner BM (1986) Role of atrial natriuretic peptide in adaption of sodium excretion with reduced renal mass. J Clin Invest 77: 1395–1398PubMedCrossRefGoogle Scholar
  25. 25.
    Talartschik J, Eisenhauer T, Voth E, Sold G, Scheler F (1988) Ist der Plasma-ANP-Spiegel ein Index für die Volumenexpansion bei Dialysepatienten? Z Kardiol 77 [Suppl 2]: 72–77PubMedGoogle Scholar
  26. 26.
    Wilkins MR, Wood JA, Adu D, Lote CJ, Kendall MJ, Michael J (1986) Change in plasma immunoreactive atrial natriuretic peptide during sequential ultrafiltration and haemodialysis. Clin Sci 71: 157–160PubMedGoogle Scholar
  27. 27.
    Yamamoto Y, Higa T, Kitamura K, Tanaka K, Kangawa K, Matsuo H (1985) Plasma concentration of atrial natriuretic polypeptide in chronic hemodialysis patients. Regulatory Peptides 4 [Suppl]: 110–112Google Scholar
  28. 28.
    Yamamoto Y, Higa T, Kitamura K, Tanaka K, Kangawa K, Matsuo H (1987) Plasma concentration of human atrial natriuretic polypeptide in patients with impaired renal function. Clin Nephrol 27: 84–86PubMedGoogle Scholar
  29. 29.
    Yandle TG, Richards AM, Nicholls MG, Cuneo R, Espiner EA, Livesey JH (1986) Metabolic clearance rate and plasma half life of alpha-human atrial natriuretic peptide in man. Life Sci 38: 1827–1833PubMedCrossRefGoogle Scholar
  30. 30.
    Zoccali C, Ciccarelli M, Mallamaci F, Delfino D, Salnitro F, Parlongo S, Maggiore Q (1986) Effect of ultrafiltration on plasma concentrations of atrial natriuretic peptide in haemodialysis patients. Nephrol Dial Transplant 1: 188–191PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • W. Rascher
    • 1
  • M. Bald
    • 1
  1. 1.Universitätsklinik für Kinder- und Jugendmedizin (GHS)EssenGermany

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